Provider Demographics
NPI:1104970433
Name:THOMAS, STEPHEN P (MSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:222 SAINT JOHN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3041
Mailing Address - Country:US
Mailing Address - Phone:207-828-0759
Mailing Address - Fax:207-828-0701
Practice Address - Street 1:222 SAINT JOHN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3041
Practice Address - Country:US
Practice Address - Phone:207-828-0759
Practice Address - Fax:207-828-0701
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME08251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME217030100Medicaid
ME217030000Medicaid
ME217030100Medicaid